Conference Two - Module 5 (Exam 2) 2

Question 1

Fetal Elements

Answer 1

1. FHR Baseline
2. FHR Variablity
3. FHR Periodic Changes (with contractions)
   
   1. Accelerations
   2. Decelerations
      
      1. Early
      2. Variable
      3. Late
      4. Prolonged

Question 2

External Fetal Monitoring

Answer 2

Uses an ultrasound disc to provide information re FHR baseline, FHR variablity, and periodic changes. The optimal placement is over the fetal back.

Question 3

Internal Fetal Monitoring

Answer 3

Uses a fetal scalp electrode (FSE) to provide greater detail

1. Detects electrical impulses generated by fetal cardiac activity
2. Eliminates potential interruptions caused by maternal or fetal movement during labor
3. Requires rupture of membranes and minimal cervical dilation

Question 4

Normal Fetal HR

Answer 4

110-160 BPM

Question 5

Fetal Bradycardia

Answer 5

<110 BPM persisting for at least 10 minutes

Question 6

Fetal Tachycardia

Answer 6

>160 BPM for at least 10 minutes

Question 7

FHR Baseline

Answer 7

Average heart rate (rounded to 5 BPM), measured over at least two minutes within a 10 minute window

Question 8

Fetal Bradycardia Possible Etiology

Answer 8

1. Fetal Hypoxia
2. Fetal Sleep Period (greater than or equal to 40 minutes)

Question 9

Fetal Tachycardia Possible Etiology

Answer 9

1. Maternal infectious process
2. Maternal Dehydration

Question 10

Nursing Interventionsfor Fetal Bradycardia and Tachycardia

Answer 10

1. Monitor closely
2. Increase placental blood flow/oxygenation to fetus
3. Side-lyingposition
4. O2
5. IVF
6. Collaborate to determine and address underlying cause

Question 11

FHR Variability

Answer 11

The interplay between the fetal sympathetic and parasympathetic nervous system

Indicated by oscillations above and below baseline FHR, measured overat least two minutes during a ten-minute window

Question 12

Moderate Variability

Answer 12

6-25 BPM above and below baseline

Indicates a well-oxygenated fetal nervous system and is considered very strong indicator of fetal wellness

Question 13

Minimal Variability

Answer 13

less than or equal to 5BPM above and below baseline

Question 14

Marked Variability

Answer 14

greater than or equal to 26BPM

Question 15

Minimal Variability Etiology

Answer 15

Less than or equal to 5BPM

1. Fetal Sleep Period
2. Maternal Narcotic or sedative medication
3. Fetal Tachycardia
4. Fetal Sepsis
5. Impaired Fetal oxygenation/hypoxia

Question 16

Nursing Interventions for Minimal Variability

Answer 16

1. Observe carefully
2. Prepare to intervene:
   
   1. Side-lying position
   2. O2
   3. IVF
   4. Collborate to address underlying cause

Question 17

Marked Variability Etiology

Answer 17

Greater than or equal to 25 BPM

1. CNS and/or cardiac anomlies
2. Severe bradycardia

Question 18

Marked Varibility Nursing Interventions

Answer 18

Collaborate to address

Question 19

FHR Acceleration

Answer 19

An abrupt increase above the FHR baseline, peaking at a minimum of 15 BPM and lasting for at least 15 seconds (15X15)

• Accelerations may be periodic (with contractions)
• Accelerations may be non-periodic (independent of contractions)
• Accelerations are considered a reassuring sign, indicating a well-oxygenated fetal nervous system

Question 20

Early Decelerations

Answer 20

Caused by fetal head compression and stimulation of the vagus nerve (slows heart rate). They have a shallow waveform, often mirroing the contraction. Benign.

Question 21

Late Decelerations

Answer 21

Caused by uteroplacental insufficiency and are always a serious indicator of potential for compromise. They literally occur later than a contraction.

Question 22

Variable Deceleration

Answer 22

Concerning. Caused by cord compression. They fall and rise abruptly, often dropping precipitously. Although they are most often periodic, they may also be non-periodic.

Question 23

Early deceleration etiology and interventions

Answer 23

1. Head compression
2. Often seen early active phase or with highly + station

Document and teach

Question 24

Late Deceleration Etiology

Answer 24

1. Uteroplacental insufficiency

Question 25

Late Deceleration Nursing Interventions

Answer 25

1. Remain with patient/report
2. Left side-lying position
3. O2 at 8-10 L VIA mask
4. Stop Pitocin infusion/ increase IVF
5. Potential urgent delivery

Question 26

Variable Decelerations Etiology and Interventions

Answer 26

Cord Compression

1. Remain with patient
2. Position changes: left, right, knee to chest
3. O2 at 8-10L VIA mask
4. Stop Pitocin infusion/ increase IVF
5. Amnioinfusion (put fluid back in)

Question 27

Prolonged Decelerations

Answer 27

Duration 2-10 minutes

Prepare for urgent delivery

Question 28

Category 1

Answer 28

1. FHR 100-160 BPM
2. Moderate Variabilty
3. No variable or late decelerations
4. Possible early decelerations or accelerations

Question 29

Category 3

Answer 29

1. Variable or late decelerations
2. Bradycardia
3. No variablity